Provider Demographics
NPI:1215041835
Name:BABB, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BABB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-1156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2888 EUREKA WAY
Practice Address - Street 2:STE 100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0210
Practice Address - Country:US
Practice Address - Phone:530-243-7600
Practice Address - Fax:530-242-0808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64731207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A647310Medicaid
00A647310Medicare ID - Type Unspecified
CA00A647310Medicaid